Cadernos de Saúde Pública
On-line version ISSN 1678-4464
CASTRO, Cláudio de Moura and VIANNA, Nilton Romeu Solon Magalhães. The Invisible hand in health: does it heal?. Cad. Saúde Pública [online]. 1985, vol.1, n.4, pp. 418-431. ISSN 1678-4464. http://dx.doi.org/10.1590/S0102-311X1985000400003.
Health services have to be paid for, regardless of the prevailing economic system. Pricing systems and market structures interfere with the deployment of health services, therefore have to be dealt wity realistically. This essay discusses four cases of interactions between markets and health delivery systems in Brazil. a) Generally, health administrators indicated that university-trained nurses should treat patients. This has never happened due to the relative scarcityand consequent high wages - of nurses trained, at levels almost equivalent to that of doctors. b) Since price of consultations is taken as a measure of quality, the enormous expansion in the number of medical doctors did not lead to lower prices that could clear the market. Instead, a very large number of insurance and medical sevice firms were created to purchase doctors' time at "wholesale " and resell it under a variety of health plans. c) Social Security services pay physicians salaries and fees which are competitive in the market but are considered too low by the doctors. As a consequence, doctors decrease, on their own initiative, the number of hours worked or procrastinate treatment in order to require more consultations. d) Several medical schools were created in the large Brazilian cities, under the assumption that the oversupply of doctors would generate an outflow of graduates towards smaller communities. For several reasons this never materialized.